Instructions: Print all pages now and fill out the order form which begins below. Fax (1-512-388-3974) or mail the order form to LEHLE SEEDS at the address below. LEHLE SEEDS ORDER FORM
Date _________________________________ Contact Person __________________________________________________________________ Contact Daytime Telephone _______________________________________________________ Contact FAX _____________________________________________________________________ Contact Email ___________________________________________________________________ PAYMENT METHOD Purchase Order [__] No. ________________________________________________________
(Important! LEHLE SEEDS must receive a copy of the official institution purchase order with this number before order will be processed and shipped.) Debit or Credit Card [__] - Visa or MasterCard Cardholder Name _________________________________________________________ Card Number _____________________________________________________________ Expiration Date _____/_____
Other Method [__] Describe in comments section below. Must conform to our terms (see http://www.arabidopsis.com/main/cat/pricing/terms.html).
SHIPPING METHOD - LEHLE SEEDS will pick best way UPS-(USA & Canada) FEDEX-(Elsewhere) Exception - Express Mail for seeds to Japan. V.A.T. or TAX ID Number _________________________________________________________ SHIPPING ADDRESS (Abbreviate long address. Physical address only; no PO Boxes.) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ TELEPHONE __________________________________FAX__________________________________
CUSTOMS BROKER (Provide name, address, telephone and fax numbers.)
_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
Can we put [__] freight charges or [__] customs duties or [__] both on your [__] FEDEX or [__] UPS account? _________________________________________
BILLING ADDRESS _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ TELEPHONE __________________________________FAX__________________________________ LIST ITEMS YOU WANT TO ORDER HERE # Quantity Cat. No. Description Unit Price Total 1. _____________________________________________________________________________ 2. _____________________________________________________________________________ 3. _____________________________________________________________________________ 4. _____________________________________________________________________________ 5. _____________________________________________________________________________ 6. _____________________________________________________________________________ 7. _____________________________________________________________________________ Special instructions or comments_________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ FAX to 1-512-388-3974 or mail completed form to LEHLE SEEDS, PO BOX 2366, ROUND ROCK TX 78680-2366 USA